Volunteer Application Volunteer Application (Please fill out ALL the fields below) "*" indicates required fields Your Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Mobile Phone*Home Phone*Emergency Contact Name* First Last Emergency Contact Relationship*Emergency Contact Cell Phone*Language(s) Spoken* English Spanish French Portuguese Creole Other Home Church*[please enter NA if not applicable]Home School*[please enter NA if not applicable]How did you hear about us?*GoogleInstagramFacebookFriendChurchOtherWhat motivates you to volunteer with Heart2Heart?*What has been your previous volunteer experience?*In what programs would you like to serve?* Heart2Heart Drivers Home-Based Projects: Cozy Blankets, Card Making Home-Based Projects: Pen Pals Care Centers: Heart2Heart Group Events Care Centers: Sunday services & Bible studies Care Centers: Face-to-Face Visits iPads for Seniors C.A.R.E. Calls Relief C.A.R.E. Community C.A.R.E. Visits Home Delivered Meal Drivers Select AllFor a description of all our programs, please visit: Outreach OpportunitiesAre you employed?* Yes No Company and Profession?*I have a previous felony or misdemeanor* Yes No Misdemeanor Date(s)*If you answered “yes” to having a previous felony or misdemeanor, please briefly describe, or you may privately discuss this with the Program Director (Not every conviction is grounds for automatic rejection).*I prefer to discuss my conviction in person with the Program Director.* Yes No Please Check Each Box* I have read and I understand the Heart2Heart Statement of Faith. If selected to participate, I understand I am representing Heart2Heart as a volunteer and not an employee of the agency. I also agree to serve without compensation and understand I am not eligible for Worker’s Compensation. I agree to abide by the policies of the Care Center and Heart2Heart's volunteer guidelines. Select AllT-Shirt Size* Small Medium Large XL 2XL 3XL Your Printed Name*E SignatureDate* MM slash DD slash YYYY
